Quality improvement and system transformation in emergency medicine

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

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147: Perceptions of Quality Improvement Practices In Academic Emergency Medicine

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2010.06.194 ◽

2010 ◽

Vol 56 (3) ◽

pp. S49

Author(s):

J. DelliFraine ◽

J. Langabeer ◽

B. King

Keyword(s):

Emergency Medicine ◽

Quality Improvement

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LO093: A national needs assessment survey for the development of a quality improvement and patient safety curriculum for Canadian emergency medicine residents

CJEM ◽

10.1017/cem.2016.130 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S62-S62 ◽

Cited By ~ 1

Author(s):

L.B. Chartier ◽

S. Vaillancourt ◽

M. McGowan ◽

K. Dainty ◽

A.H. Cheng

Keyword(s):

Emergency Medicine ◽

Medical Education ◽

Patient Safety ◽

Quality Improvement ◽

Needs Assessment ◽

Residency Training ◽

Royal College ◽

Assessment Tool ◽

Postgraduate Medical Education ◽

Clinical Scenarios

Introduction: The Canadian Medical Education Directives for Specialists (CanMEDS) framework defines the competencies that postgraduate medical education programs must cover for resident physicians. The 2015 iteration of the CanMEDS framework emphasizes Quality Improvement and Patient Safety (QIPS), given their role in the provision of high value and cost-effective care. However, the opinion of Emergency Medicine (EM) program directors (PDs) regarding the need for QIPS curricula is unknown, as is the current level of knowledge of EM residents in QIPS principles. We therefore sought to determine the need for a QIPS curriculum for EM residents in a Canadian Royal College EM program. Methods: We developed a national multi-modal needs assessment. This included a survey of all Royal College EM residency PDs across Canada, as well as an evaluative assessment of baseline QIPS knowledge of 30 EM residents at the University of Toronto (UT). The resident evaluation was done using the validated Revised QI Knowledge Application Tool (QIKAT-R), which evaluates an individual’s ability to decipher a systematic quality problem from short clinical scenarios and to propose change initiatives for improvement. Results: Eight of the 13 (62%) PDs responded to the survey, unanimously agreeing that QIPS should be a formal part of residency training. However, challenges identified included the lack of qualified and available faculty to develop and teach QIPS material. 30 of 30 (100%) residents spanning three cohorts completed the QIKAT-R. Median overall score was 11 out of 27 points (IQR 9-14), demonstrating the lack of poor baseline QIPS knowledge amongst residents. Conclusion: QIPS is felt to be a necessary part of residency training, but the lack of available and qualified faculty makes developing and implementing such curriculum challenging. Residents at UT consistently performed poorly on a validated QIPS assessment tool, confirming the need for a formal QIPS curriculum. We are now developing a longitudinal, evidence-based QIPS curriculum that trains both residents and faculty to contribute to QI projects at the institution level.

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LO27: Relevance of Choosing Wisely Canada non-emergency medicine specialty lists to emergency medicine practice

CJEM ◽

10.1017/cem.2020.83 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S16-S17

Author(s):

S. Upadhye ◽

C. Davies-Schinkel ◽

S. Pilakka

Keyword(s):

Emergency Medicine ◽

Quality Improvement ◽

Patient Care ◽

Resource Use ◽

Emergency Departments ◽

Rating Scale ◽

Likert Scale ◽

Choosing Wisely ◽

Low Back ◽

Potential Impact

Introduction: The Choosing Wisely Canada (CWC) initiative is dedicated towards optimizing patient care and reduce unnecessary resource use. Different specialty organizations create recommendations lists towards these outcomes. The goal of this study was to examine the applicability of non-Emergency Medicine (EM) recommendations towards EM practice. Methods: The entire master recommendations listings spreadsheet was downloaded from the CWC website (March 2019; n = 333). The EM-specific items from the CAEP checklist were deliberately excluded (n = 10). Items were rated by Niagara community EM physicians (n = 7) using the previously validated Best Evidence in Emergency Medicine (BEEM) rating scale (7 point Likert scale) to determine potential impact on EM practice. Items rated “6 or 7/7” were determine as “high relevance.” Redundant items were consolidated. Results: From the retrieved CWC master list, a total of 102 “highly relevant” recommendations were identified (41 items scored 6/7 [12%], 61 scored 7/7 [18%]; total 31%). Redundant items consolidated included antimicrobial avoidance (n = 18), opioid avoidance for pain (n = 11), reduction of unnecessary imaging (n = 11), and avoidance of routine low back imaging (n = 7). Conclusion: There are a large number of non-EM specialty recommendations highly relevant to EM practice in the CWC database (31%). Quality improvement initiatives looking to operational CWC recommendations in Canadian Emergency Departments should be aware of these as a part of optimizing patient care.

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The appropriate use of CT: quality improvement and clinical decision-making in pediatric emergency medicine

Pediatric Radiology ◽

10.1007/s00247-011-2102-7 ◽

2011 ◽

Vol 41 (S2) ◽

pp. 498-504 ◽

Cited By ~ 29

Author(s):

Charles G. Macias ◽

Julieanna J. Sahouria

Keyword(s):

Decision Making ◽

Emergency Medicine ◽

Quality Improvement ◽

Clinical Decision Making ◽

Clinical Decision ◽

Pediatric Emergency ◽

Pediatric Emergency Medicine ◽

Appropriate Use

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Residents’ perspective of quality improvement and patient safety education in Canadian emergency medicine residency programs

CJEM ◽

10.1017/cem.2019.465 ◽

2020 ◽

Vol 22 (2) ◽

pp. 224-231

Author(s):

Sachin V. Trivedi ◽

Riley J. Hartmann ◽

Justin N. Hall ◽

Laila Nasser ◽

Danielle Porplycia ◽

...

Keyword(s):

Emergency Medicine ◽

Patient Safety ◽

Quality Improvement ◽

Royal College ◽

Free Text ◽

Safety Education ◽

Delivery Of Care ◽

Residency Programs ◽

Electronic Survey ◽

Local Setting

ABSTRACTObjectivesQuality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents’ perspectives on the level of QIPS education and support available to them.MethodsAn electronic survey was distributed to all Canadian EM residents from the Royal College and Family Medicine training streams. The survey consisted of multiple-choice, Likert, and free-text entry questions aimed at understanding familiarity with QIPS, local opportunities for QIPS projects and mentorship, and the desire for further QIPS education and involvement.ResultsOf 535 EM residents, 189 (35.3%) completed the survey, representing all 17 medical schools; 77.2% of respondents were from the Royal College stream; 17.5% of respondents reported that QIPS methodologies were formally taught in their residency program; 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS; 47.2% and 51.5% of respondents reported either “not knowing” or “not having readily available” opportunities for QIPS projects and QIPS mentorship, respectively; 66.9% of respondents indicated a desire for increased QIPS teaching; and 70.4% were interested in becoming involved with QIPS training and initiatives.ConclusionsMany Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.

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